Provider Demographics
NPI:1518612365
Name:VALESSA COMMUNITY SERVICES INC
Entity Type:Organization
Organization Name:VALESSA COMMUNITY SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CALLOWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-533-1199
Mailing Address - Street 1:PO BOX 904
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-0904
Mailing Address - Country:US
Mailing Address - Phone:470-533-1199
Mailing Address - Fax:470-533-1187
Practice Address - Street 1:2453 POWDER SPRINGS RD SW STE 320C
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4570
Practice Address - Country:US
Practice Address - Phone:470-533-1199
Practice Address - Fax:470-533-1187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPHCP011066OtherPRIVATE